Management of Patients with Herpes Zoster

Infection-control measures depend on whether the patient with herpes zoster is immunocompetent or immunocompromised and whether the rash is localized or disseminated (defined as appearance of lesions outside the primary or adjacent dermatomes).

In all cases, follow standard infection-control precautions. Use the chart below to determine if any additional infection-protocol precautions are required.

Localized HZ

Disseminated HZ

Immunocompetent Patient

Completely cover lesions and follow standard precautions until lesions are dry and crusted

Airborne and contact precautions until lesions are dry and crusted

Immunocompromised Patient

Airborne and contact precautions until disseminated infection is ruled out.

After dissemination is ruled out, completely cover lesions and follow standard precautions until lesions are dry and crusted

Airborne and contact precautions until lesions are dry and crusted.

Management of Healthcare Personnel

Consider the following recommendations when healthcare personnel are exposed to someone with varicella or herpes zoster.

Healthcare personnel who have 1 or more documented dose(s) of varicella vaccine or other evidence of immunity to varicella:

Do not need postexposure prophylaxis

Do not need work restrictions

Should ensure they are up to date with 2 documented doses of varicella vaccine.

If they have only 1 documented dose of varicella vaccine, they should receive the second dose within 3 to 5 days after exposure, as long as 4 weeks have elapsed since the first dose.

Should self-monitor, or have the employee health program or an infection control nurse monitor, during days 8 to 21 after exposure and immediately report any fever, headache, skin lesions, or systemic symptoms.

If symptoms occur, immediately remove healthcare personnel from patient care, place them on sick leave, and provide them with antiviral medication if symptoms occur

Healthcare personnel who are not vaccinated or do not have other evidence of immunity to varicella

are considered susceptible to VZV infection

are potentially infectious from days 8 to 21 after exposure.

should be furloughed or temporarily reassigned to locations remote from patient-care areas from the 8th day after the first exposure through the 21st day after the last exposure

should receive postexposure vaccination in according with ACIP and CDC recommendation

if varicella zoster immune globulin is administered as postexposure prophylaxis, exclude from work from the 8th day after the first exposure through the 28th day after the last exposure.

should be vaccinated within 3 to 5 days of exposure to rash. Vaccination 6 or more days after exposure is still indicated because it induces protection against subsequent exposures if the current exposure did not cause infection

should instead receive varicella-zoster immune globulin if they are at risk for severe disease and varicella vaccination is contraindicated (e.g., pregnant healthcare personnel)

Recommendations for healthcare institutions to prevent varicella and nosocomial spread

have documented evidence of immunity for all healthcare personnel readily available at the healthcare personnel’s work location

alert healthcare personnel without evidence of immunity to varicella about the risks of possible infection and offer those without evidence of immunity 2 doses of varicella vaccine, administered 4 to 8 weeks apart, when they begin employment

establish protocols and recommendations for screening and vaccinating healthcare personnel and for managing healthcare personnel after exposures in the work place